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Culture Documents
a. AR (LQ 2012)
b. Thyrotoxicosis
c. Hyperkinetic heart syndrome
d. Fever
e. Arteriovenous fistula
f. Patent ductus arteriosus
g. Pregnancy
h. Beri Beri
Causes of secondary hypertension
Renal disease: The most common Q secondary cause.
1. Glomerulonephritis, (Acute & Chronic)
2. Chronic pyelonephritis,
3. Renovascular disease (Renal artery stenosis)
most frequently atheromatous (elderly,
cigarette smokers with periphery vascular
disease) or fibro muscular dysphasia Q in
young patients.
RAS, can occur in Takayasu disease but it
does not occur in PAN. (LQ, AIPG 2010)
4. Polycystic kidneys.
5. Renin secreting tumor.
Extra Edge:
1. Renovascular Hypertension (Ref. Hari. 18th ed.,
pg - 2049)
a. As a screening test, renal blood flow
may be evaluated with a radionuclide
[131I]-orthoiodohippurate (OIH) scan or
glomerular filtration rate may be
evaluated with a DTPA scan before
and after a single dose of captopril (or
Autosomal recessive
Autosomal dominent
1. 17-hydroxylase
deficiency
2. 11-hydroxylase
deficiency
3. 11-
1. Liddle's syndrome
2. Pseudohypoaldosteronism
type II (Gordon's syndrome)
3. Polycystic kidney disease
4. Pheochromocytoma
hydroxysteroid
dehydrogenase
deficiency (apparent
mineralocorticoid
excess syndrome)
Hypertensive retinopathy
Grade
1. Tortuous with thick shiny walls
4. Papilledema
Hypertension Management
Basic Physiology of BP
Physiological Parameters on which BP depends
1. Cardiac output
2. Peripheral resistance
3. Blood volume
BP = Cardiac output (COP) x Peripheral resistance (PR)
COP = Heart Rate (HR) x Stroke volume (SV)
BP = HR x SV x PR
(Mean Arterial Pressure = Diastolic BP + 1/3 pulse
presence)
c. Severe hypertension Q
C. Drugs which reduce the peripheral resistance
1. Alpha blockers
2. Calcium channel blockers
3. ACEI
4. Direct vasodilators
1. Alpha blockers: They act on the peripheral alpha
receptors thereby dilate the arteriole.
Examples: Prazosin,
Uses of alpha blockers in hypertension
a. Elderly Q
b. HT with BHP
c. HT with CRF
d. HT with hyperuricemia
2. Calcium channel blockers : They dilate the
arteriole so reduce the peripheral resistance
Example: Nifedipin
Uses
a. Elderly hypertensive
b. HT with CRF
c. HT with PVD
d. HT with SAH (Nimodipine is used) (MCQ)
Contraindication
a. HT with CAD
b. Malignant hypertension
c. HT with CHF
c. HT with DM
d. HT with CHF
e. HT with MI
f. HT with hyperuricemia
g. HT with erectile dysfunction
Side Effects: Cough (M/C), Hyperkalemia (LQ, AIIMS
Nov 2010), Angioneurotic edema, First dose
hypotension.
Captopril causes leukopenia & nephrotic syndrome.
Contraindication
a. Bilateral renal artery stenosis
b. CRF
c. With potassium sparing diuretics
d. Pregnancy
4. Direct Vaso dilators
Example: Hydralazine, alpha Methyl dopa,
Sodium nitroprusside, indapamide
a. Hydralazine
Pregnancy with HT
Side effect : SLE like syndrome
b. Alpha methyl dopa
Uses
Pregnancy with HT
Side effects: Coombs positive hemolytic
anemia, black tongue
c. Sodium nitroprusside
Uses: Hypertensive emergencies,
Malignant hypertension
d. d Indapamide
Uses
i. HT with hyperuricemia
ii. HT with CRF
iii. HT with diabetes
iv. Elderly hypertensive
Extra Edge: (Ref. Hari. 18th ed., pg - 2010)
1. Verapamil ordinarily should not be combined
with beta blockers because of the combined
adverse effects on heart rate and contractility.
2. Diltiazem can be combined with beta blockers
in patients with normal ventricular function
and no conduction disturbances.
3. Amlodipine and beta blockers have
complementary actions on coronary blood
supply and myocardial oxygen demands.
Recent Advances:
1. Bosentan is a new drug. It is a endothelin
receptor antagonist. It is a vaso dilator It has
been approved for PAH and for Raynauds
phenomena.
Resistant Hypertension
1. It refers to patients with BP persistently >140/90
mmHg despite taking three or more
antihypertensive agents, including a diuretic, in
reasonable combination and at full doses.
2. Resistant hypertension may be related to
a. "Pseudoresistance" (high office blood
pressures and lower home blood
pressures),
b. Non adherence to therapy,
c. Identifiable causes of hypertension
(including obesity and excessive alcohol
intake), and use of any of a number of
nonprescription and prescription drugs.
hypertensive urgency.
2. Hypertensive urgency indicates that the blood
pressure is high enough to cause serious risk
of sudden, life threatening events, but that no
such events are currently occurring.
3. In other words, these patients have no organ
failure or other immediately life threatening
conditions, but could quickly develop them if
their blood pressure isnt quickly brought
under control.
4. Patient should be treated on the OPD basis.
(i.e. Hospitalization not needed)
Diet in Hypertensive patient:
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